A new trend is emerging among nurse practitioners and PAs in primary care. Increasingly, more NPs and PAs are selecting subspecialties despite primary care being their original focus.

Primary care is no longer the main career path for many nurse practitioners (NPs) and physician assistants (PAs). An August 2013 study published in the American Academy of Family Physicians (AAFP) found that a growing number of NPs and PAs are selecting subspecialty practices instead of working in primary care. Sub-specialization offers more career options to NPs and PAs than before, when primary care was the main focus.

2013 AAFP Study

The AAFP research team at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care reviewed job stats from the National Provider Identifier (NPI) and discovered that less than half of PAs and a little over 50 percent of NPs work in primary care. This was an unexpected finding, since 2012 the U.S. Bureau of Labor Statistics showed a larger percentage of NPs and PAs employed in primary care practice settings than specialty practices.

Since registering with the NPI is required for all clinicians who file insurance claims, it can provide data on PA and NP practice locations and associated physicians. The NPI assumes that any NP or PA practicing without an associated physician is working in primary care. This means that the number of PAs and NPs assumed to be practicing primary care by NPI may even be lower.

The U.S. Department of Health and Human Services details the active recruitment of NPs and PAs in its description of how the Affordable Health Care Act and the American Recovery and Reinvestment Act of 2009 protect primary care services. Yet, it appears that the number of NPs and PAs working in primary care has been dwindling in recent years. This theory is also supported by the recent Annals of Family Medicine study.

This career trend demonstrates that NPs and PAs, as well as physicians, are also in short supply in primary care.

New Career Trends For NPs And PAs

Working in specialty practices often provides greater flexibility for many NPs and PAs. Specialty practices may feature benefits such as:

Set work hours and less overtime

Flexible work schedules — part-time or full-time

Higher pay for specialty expertise

More practice setting options

Subspecialty Career Trends For PAs

PAs work in subspecialties in many medical fields. Examples of subspecialties open to PAs include:

General surgery

Orthopedic surgery

Pediatrics

Anesthesiology

Radiology

Occupational medicine

Addiction medicine

Psychiatry

NP Subspecialty Career Options

The medical field offers a variety of options for NPs who want to work in a specialty. These examples of NP subspecialties demonstrate the many career focus possibilities:

Flight nursing (acute and emergency care)

Cardiology

Nurse Midwifery

Neonatology

Oncology

Psychiatry

Dermatology

Endocrinology

Outlook For NP And PA Career Trends

There are many job opportunities for NPs and PAs in both subspecialties and primary care, according to the Advanced Health Care Network. The Bureau of Labor Statistics predicts that there will be a 23 percent increase in the amount of available nursing jobs and a 41 percent increase in available positions for PAs by 2018. In rural and urban areas, there is a high need for NPs and PAs. As more jobs become available over the years, NPs and PAs will have their pick of both primary care and subspecialty positions.